"The world sleeps in the face of the greatest disaster to face Homo sapiens in recorded history. Future historians will marvel."

The failure to mount a global response in proportion to the threat posed by the AIDS pandemic was characterized recently by Richard Feachem, Executive Director of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, in no uncertain terms and in a way that should make each of us stop and think.

It is not the case -- and neither, I am certain, did Feachem mean to say -- that nothing is being done. Despite all of our current efforts, however, we know that we are not doing enough. We are aware that tens and even hundreds of millions of people will suffer and die unnecessarily if we do not increase global and national efforts to prevent infection and treat those already infected. And, thus, Feachem is correct; if more is not done, future historians will certainly look back at this time with a sense of horrified awe. As has been the case with other preventable tragedies of world historical proportion, the chroniclers of the AIDS pandemic will look back through the years, decades, and centuries to ask, "Why did the people of the world not do more?"

Similar to the way in which certain images have come to stand for past tragedies, I suspect that the AIDS pandemic, if the world does not fully do what it must, will be remembered in symbols that sit in society's collective minds' eye as haunting reminders of cruelty and indifference. In Rwanda we think of rivers choked with bludgeoned corpses. For the atrocities of the Khmer Rouge, one recalls photographs of heaping mounds of sun-bleached skulls. The gas chambers of Auschwitz symbolize one of the modern world's most notorious examples of senseless destruction, the Nazi Holocaust. And, I fear that news reports coming out of South Africa last month describe a circumstance that might become, as with these others, an image shocking to future generations because it represents the failure to prevent preventable suffering: the municipal government of Johannesburg is considering a plan to bury in abandoned mineshafts the thousands felled by AIDS whose corpses cannot be accommodated in the city's rapidly filling cemeteries.

As reported in the British magazine New Scientist, "Old gold mines could be converted into underground streets lined with tombs, accessed from ground level by lifts." Alan Buff, the head of Johannesburg's public cemeteries, believes that this or other drastic measures have become inevitable. He stated that Johannesburg, whose citizens eschew cremation, must plan to bury 70,000 people each year by 2010, several times more than the 20,000 people (already a greatly increased number) who were interred in 2002.

What will these numbers be like by mid-century, when epidemiologists predict that the pandemic, continuing its current trajectory, might finally peak? What will they be like in Bombay and Beijing, two cities where AIDS will likely infect millions in years ahead? And when the people of the world know the answers to these questions, will they look back at eerie tunnels filled with the bodies of young South Africans who died from a disease that is preventable and treatable and ask why it was allowed to happen?

We must do all within our power to avoid this human catastrophe. When we count on such information and ability as we possess today, we have no moral recourse but to act now. Failing to prevent a death, when preventing that death is entirely within one's ability, is tantamount to an abrogation of our collective humanity. The same is true on a global scale, so that if the world allows countless millions to suffer and die from HIV disease, it will be an act of moral depravity approaching that of genocide. We cannot let this possibility come to pass. Let us rout out indifference and choose the path of compassion and action. Let us recognize and be brought to indignation now by the signs of suffering that are in our midst -- lest they come back as terrible symbols to haunt us and our world for generations to come.

José M. Zuniga is President of the International Association of Physicians in AIDS Care, and Editor-in-Chief of the IAPAC Monthly.

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